Enhancing cervical and breast cancer training in Africa with e-learning
Authors: Joel Fokom Domgue, Issimouha Dille, Laura Fry, Rosine Mafoma, Celine Bouchard, David Ngom, Nathalie Ledaga, Freddy Gnangnon, Mamadou Diop, Bangaly Traore, Mala Pande, Joseph Kamgno, Mohenou Isidore Diomande, Pierre-Marie Tebeu, Fabrice Lecuru, Marie Plante, Jean-Marie Dangou, Sanjay Shete
Journal: The Lancet Global Health (2022)

The African continent carries a high share of the global cancer burden, with cervical and breast cancers being the main drivers of cancer-related morbidity and mortality in the region.1Bray F Parkin DM Gnangnon F et al.Cancer in sub-Saharan Africa in 2020: a review of current estimates of the national burden, data gaps, and future needs.Lancet Oncol. 2022; 23: 719-728Summary Full Text Full Text PDF PubMed Scopus (31) Google Scholar Although the burden of cervical cancer has drastically decreased in high-income countries in the past three decades because of the widespread implementation of screening, early detection, human papillomavirus vaccination programmes, and improvements to accessing comprehensive cancer treatment services, nearly 90% of new cases and deaths from this preventable disease are from low-income and middle-income countries, and 19 of the 20 countries with the highest incidence rates worldwide are in Africa.2WHOCervical cancer.https://www.who.int/health-topics/cervical-cancer#tab=tab_1Date: 2020Date accessed: October 11, 2022Google Scholar Breast cancer burden in Africa is also alarming. In the African region defined by WHO, breast cancer is the most common cancer and accounted for 16·5% of all new cancer cases in 2020.2WHOCervical cancer.https://www.who.int/health-topics/cervical-cancer#tab=tab_1Date: 2020Date accessed: October 11, 2022Google Scholar Women in Africa diagnosed with breast cancer have much lower survival rates, although they are generally younger than people with breast cancer in high-income settings.1Bray F Parkin DM Gnangnon F et al.Cancer in sub-Saharan Africa in 2020: a review of current estimates of the national burden, data gaps, and future needs.Lancet Oncol. 2022; 23: 719-728Summary Full Text Full Text PDF PubMed Scopus (31) Google Scholar For every 100 deaths of African women from breast cancer younger than 50 years, there are an estimated 210 new orphans,3Galukande M Schüz J Anderson BO et al.maternally orphaned children and intergenerational concerns associated with breast cancer deaths among women in sub-Saharan Africa.JAMA Oncol. 2021; 7: 285-289Crossref PubMed Scopus (13) Google Scholar highlighting the societal effect of breast cancer in the region. To urge countries to take concerted actions to tackle these global health challenges, WHO has launched two major initiatives: the Cervical Cancer Elimination Initiative in 20204WHOThe Cervical Cancer Elimination Initiative.https://www.who.int/initiatives/cervical-cancer-elimination-initiativeDate: 2020Date accessed: October 11, 2022Google Scholar and the Global Breast Cancer Elimination Initiative in 2021.5WHOThe Global Breast Cancer Initiative.https://www.who.int/initiatives/global-breast-cancer-initiativeDate: 2021Date accessed: October 21, 2022Google Scholar In addition to the limited availability of screening, diagnostic, and treatment services, the scarcity of a well trained oncology workforce is a major impediment to the fight against cancer in Africa.6Ngwa W Addai BW Adewole I et al.Cancer in sub-Saharan Africa: a Lancet Oncology Commission.Lancet Oncol. 2022; 23: e251-e312Summary Full Text Full Text PDF PubMed Scopus (46) Google Scholar As Africa faces a shortage of oncology mentors, collaborative educational initiatives with mentors and trainers within and outside the continent are essential. In July 2022, the Union for International Cancer Control organised a regional dialogue to inventory existing initiatives and identify barriers to the control of cancers that primarily affect women in francophone Africa and highlighted a shortfall of oncology training programmes in the region.7Union for International Cancer ControlReport of the regional dialogue on women's cancer in francophone Africa, Abidjan.https://www.uicc.org/sites/main/files/atoms/files/UICC_Regional-Dialogue_Abidjan-Report_FA_Single.pdfDate: July 2022Date accessed: September 21, 2022Google Scholar At the World Cancer Congress held during October 18–20, 2022 in Geneva, Switzerland, collaborative and integrated approaches and partnerships to optimise strategies to reduce the burden of cancers affecting women in Africa were further explored. WHO's global strategy on digital health reports that the innovative use of cutting-edge information and communications technologies will be essential in the provision of more equitable health care,8WHOGlobal Strategy on Digital Health 2020–2025.https://www.who.int/docs/default-source/documents/gs4dhdaa2a9f352b0445bafbc79ca799dce4d.pdfDate accessed: September 21, 2022Google Scholar as these technology-enabled breakthroughs can increase access to services in underserved communities, including in Africa where the use of information and communications technologies is growing rapidly.9WHO Global Observatory for eHealthNew horizons for health through mobile technologies: second global survey on eHealth.https://apps.who.int/iris/handle/10665/44607Date accessed: September 22, 2022Google Scholar In line with these WHO recommendations, a few e-learning initiatives adapted to the African context have been implemented to build the capacity of providers in oncology,10Karim S Sunderji Z Jalink M et al.Oncology training and education initiatives in low and middle income countries: a scoping review.Ecancermedicalscience. 2021; 151296Crossref PubMed Scopus (10) Google Scholar some of which have shown promising results.11Fokom Domgue J Pande M Yu R et al.Development, implementation, and evaluation of a distance learning and telementoring program for cervical cancer prevention in Cameroon.JAMA Netw Open. 2022; 5e2240801Crossref PubMed Scopus (2) Google Scholar Such programmes can contribute to the reduction of the cancer burden in remote and hard-to-reach settings by spreading knowledge and evidence-based practices among providers without them having to move from their community. Because existing e-learning programmes were mainly done in English, participation of French-speaking clinicians in Africa has been low. To address the cultural and linguistic barriers to accessing oncology training in Africa, we used our experience with establishing and maintaining effective distance-learning programmes in English, and developed a telementoring programme for French-speaking health-care providers in participating countries in Africa involved in the prevention and management of women's cancers, using the Extension for Community Healthcare Outcome (ECHO) model.11Fokom Domgue J Pande M Yu R et al.Development, implementation, and evaluation of a distance learning and telementoring program for cervical cancer prevention in Cameroon.JAMA Netw Open. 2022; 5e2240801Crossref PubMed Scopus (2) Google Scholar Through a collaboration with the WHO African Regional Office, stakeholders from health-care facilities, ministries of health from many francophone African countries, and Cervical and Breast Cancer Volunteer Experts from Africa, Canada, France, and the USA, in February 2022 we launched the Francophone Africa Women's Cancer ECHO—an innovative distance-learning programme in French to enhance continuing education of health-care providers in francophone African countries. In this programme, video conferences in the form of virtual tumour boards are organised every last Friday of the month, during which providers select and present clinical cases of cervical and breast pre-cancers or cancers, and receive tailored guidance from a panel of renowned experts on the diagnosis, treatment, and follow-up of patients, with an emphasis on evidence-based practices. The case-based learning (two to three clinical cases per session) is complemented by a didactic lecture given by an expert on a topic of interest to participants. These monthly ECHO sessions that last for 90 min (60 min for the case-based discussion and 30 min for the didactic lecture) are interactive, with participants providing inputs or asking questions to experts and exchanging field experience with their peers to foster the knowledge transfer process. Since the programme's inception, the total number of attendees from 15 African countries has gradually increased, averaging 30–35 participants per session. An evaluation done 6 months after the programme started found that most ECHO attendees enjoyed the opportunity to learn with their peers (19 of 19), applied knowledge gained during these ECHO sessions in their clinical practice (12 of 19), reported an increased ability to offer more comprehensive care to their patients (17 of 19), adopted best-practice care through these ECHO sessions (11 of 19), and developed additional clinical expertise (13 of 19; table).TableEvaluation of the Francophone Africa Women's Cancer Project ECHOAgreeNeutralDisagreeI enjoy the opportunity to learn with peers1900The opportunity to connect with academic specialists is important to me1800I am confident when presenting patient cases during ECHO sessions8100The topics presented in didactics are relevant to my practice1720The level of detail in the didactics is appropriate1810There is enough time for questions and discussion during the ECHO sessions1432I learn from providers who present their patient cases during ECHO sessions1800I have applied knowledge learned in ECHO sessions to patients in my practice1270I have adopted best practice care through my participation in ECHO sessions1180I have developed additional clinical expertise through ECHO sessions1360Participating in ECHO sessions is an effective way for my clinic to enhance its expertise1630Participation in ECHO sessions increases my ability to offer more comprehensive care1720ECHO session participation improved the coordination of care for my patients1081I enjoy consulting with specialists about my patients' management1530Satisfaction of the Francophone Africa Women's Cancer Project ECHO attendees based on given evaluation statements and the impact of the Francophone Africa Women's Cancer Project ECHO on the knowledge, skills, and practice of clinical providers. ECHO=Extension for Community Healthcare Outcome. Open table in a new tab Satisfaction of the Francophone Africa Women's Cancer Project ECHO attendees based on given evaluation statements and the impact of the Francophone Africa Women's Cancer Project ECHO on the knowledge, skills, and practice of clinical providers. ECHO=Extension for Community Healthcare Outcome. The limited and uneven distribution of the oncology workforce in Africa, which is exacerbated by cultural and socioeconomic barriers to accessing care, can be substantially addressed by promoting and enhancing culturally appropriate digital health programmes. Programmes such as ours can improve the quality and standard of care patients receive in underserved settings, leading to a reduction in health-care inequities in Africa. We declare no competing interests. Digital solutions for early breast cancer detectionBy 2040 , more than 3 million new cases of breast cancer and 1 million deaths are estimated to occur each year worldwide. Identifying those at greatest risk of developing life-threatening breast cancers is a public-health priority. In this issue of The Lancet Digital Health, Ash Kieran Clift and colleagues developed and evaluated four prognostic models to predict 10-year risk of breast cancer mortality in women aged 20–90 years. The best performing model could be used to identify women at high risk of mortality, including those too young for breast cancer screening. Full-Text PDF Open Access